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About ICU Liberation

The Society of Critical Care Medicine's ICU Liberation campaign aims to liberate patients from the harmful effects of pain, agitation, and delirium in the intensive care unit.

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The Society of Critical Care Medicine’s (SCCM) ICU Liberation initiative aims to liberate patients from the harmful effects of pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS) in the intensive care unit (ICU). This initiative aims to improve patient outcomes after an ICU stay and reduce the risk of long-terms consequences from an ICU stay.

Among the harmful effects possible is post-intensive care syndrome (PICS), defined as new or increased physical, cognitive, or mental health impairment in a patient after hospitalization in a critical care unit.

Through the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS Guidelines, and the ICU Liberation Bundle (A-F), the ICU Liberation initiative seeks to empower the multiprofessional team to provide care that can improve outcomes for patients after they leave the ICU.

Studies have shown that implementing ventilator weaning protocols, maintaining light levels of sedation, and preventing and managing delirium can improve patient outcomes. Early mobilization and family engagement also play a key role in reducing long- and short-term consequences of an ICU stay. The greatest benefit occurs when these interventions are combined.

ICU Liberation offers numerous tools and resources to educate each member of the multiprofessional team on how to implement these interventions.

PADIS Guidelines
The PADIS Guidelines foster the delivery of excellent care in these areas and stimulate the completion of pragmatic, patient-centered research across each of these important critical care domains.

ICU Liberation Bundle (A-F)
The ICU Liberation Bundle (A-F) offers guidance on how to implement the guidelines. ICU Liberation provides resources related to bundle implementation, including those specific to each bundle element..

The Evolution of ICU Liberation Bundle (A-F)

In 2013, the Society of Critical Care Medicine (SCCM) created the ICU Liberation campaign based on the publication of the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium (PAD) in Adult Patients in the Intensive Care Unit in Critical Care Medicine. The guidelines were updated in 2018. The ICU Liberation Bundle (A-F), which represents the implementation strategy used to provide each of the recommendations in the guideline to every patient, complements the guideline.

In 2014, SCCM was awarded a grant from the Gordon and Betty Moore Foundation to study clinical practice integration and further dissemination of the 2013 PAD guidelines. The original ABCDE Bundle, sometimes referred to as the A-E Bundle, was expanded to include the Family element, evolving into the ABCDEF Bundle or A-F Bundle. During a 20-month period, 77 adult and pediatric academic, community, and federal ICUs collected data and shared best practices as they implemented the ABCDEF Bundle. Implementation of the ABCDEF Bundle showed significant and clinically meaningful outcomes, including survival, mechanical ventilation use, coma, delirium, restraint-free care, reduction in ICU readmissions, and alterations in post-ICU discharge disposition (Pun et al. Crit Care Med. 2019;47:3-14). 

As new science comes to the forefront and informs changes that lead to improved patient- and family-centered care, the bundle evolves along with it. Now officially recognized as the ICU Liberation Bundle, these evidence-based practices together help to standardize care processes, reduce practice variation, and improve ICU team communication by ensuring that all bundle elements are applied appropriately and consistently to all patients. 

The ICU Liberation Bundle consists of the following individual elements: 

A: Assess, Prevent, and Manage Pain 
B: Both Spontaneous Awakening Trials (SATs) and Spontaneous Breathing Trials (SBTs) 
C: Choice of Analgesia and Sedation 
D: Delirium: Assess, Prevent, and Manage 
E: Early Mobility and Exercise 
F: Family Engagement and Empowerment 

ICU Liberation is an evolved philosophy and practice of improving care by freeing patients from pain, oversedation, delirium, mechanical ventilation, immobility, isolation, sleep disturbances, and ICU-acquired weakness, as well as post-discharge residual effects that can be life-altering for so many patients. It also aims to increase ICU patient and family involvement and encourages enhanced interprofessional team communications.